Provider Demographics
NPI:1003120114
Name:GUTKIN, ALLA
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:GUTKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3848
Mailing Address - Country:US
Mailing Address - Phone:908-470-2745
Mailing Address - Fax:908-470-0251
Practice Address - Street 1:544 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3848
Practice Address - Country:US
Practice Address - Phone:908-470-2745
Practice Address - Fax:908-470-0251
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02630700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist